1 – None or a little of the time
2 – Some of the time
3 – Good part of the time
4 – Most or all of the time
¹
1
2
3
4
1
I feel more nervous and anxious than usual.
2
I feel afraid for no reason at all.
3
I get upset easily or feel panicky.
4
I feel like I'm falling apart and going to pieces.
5
I feel that everything is all right and nothing bad will happen.
6
My arms and legs shake and tremble.
7
I am bothered by headaches, neck and back pains.
8
I feel weak and get tired easily.
9
I feel calm and and can sit still easily.
10
I can feel my heart beating fast.
11
I am bothered by dizzy spells.
12
I have fainting spells or feel faint.
13
I can breath in and out easily.
14
I get feelings of numbness and tingling in my fingers and toes.
15
I am bothered by stomachaches or indigestion.
16
I have to empty my bladder often.
17
My hands are usually dry and warm.
18
My face gets hot and blushes.
19
I fall asleep easily and get a good night's rest.
20
I have nightmares.